How + Why To Do an Elimination Diet

You really just want to feel healthier – have more energy, maybe shed a few pounds, sleep a little better, and get rid of some bothersome digestive symptoms. Nothing fancy. Or maybe you have a chronic health condition you are trying to heal like irritable bowel syndrome, eczema, chronic allergies and sinus infections, headaches, or arthritis.

You have a hunch that changing the way you eat might help. And you’re right! Food is our first and best medicine.

But where do you start? You’ve considered doing a detox. Or maybe you should just go gluten free, or dairy free, or Paleo… But what’s the best diet for YOU? You’re completely overwhelmed by the choices.

In truth, there is no one-size-fits-all diet.

But there is one approach that is a great start for everyone!

Here’s the Secret Sauce: Start With An Elimination Diet

In my medical practice I see chronic and even serious health problems reversed every day because my patient made simple but important dietary changes based on what they experienced in their elimination diet. I have seen eczema, psoriasis, hormone problems, infertility, reflux, autoimmune diseases, diabetes, high blood pressure, high cholesterol, migraines, anxiety, chronic joint pain, gas, bloating, constipation, insomnia, chronic allergies and chronic sinus problems completely clear up – just to name a few! Patients go off of medications that they’ve been on for years!

I’ve also seen patients quickly lose the weight that they’ve been trying unsuccessfully to lose for ten years or more!

How do my patients get these results? It’s not magic or rocket science. They just get rid of the foods that are making them sick and add in foods that make people get well! It all starts with an elimination diet. And this is something you can do, too!

What is The Elimination Diet?

The Elimination Diet is an effective tool that you can use to help you identify which foods you eat that might be triggering symptoms or health problems.

It is considered THE GOLD STANDARD for identifying food sensitivities. And it costs no more than your regular groceries, doesn’t require fancy supplements, books, or videos.

Its success is based on the fact that by eliminating foods that trigger inflammation in your body, you can get rid of many symptoms and diseases that have inflammation at their root. And this means most health conditions!

The elimination diet can be done for as short a time as 2-3 weeks, but for more comprehensive results I recommend 4-6 weeks. Pick an achievable goal because you can always extend or repeat it. If you feel you can only hack the elimination phase for 3 weeks, pick the 3-week version. If you’ve got some stamina, the longer version is all yours! And if you feel you can’t do the whole elimination at once, start with 3 food categories: gluten, dairy, and sugar.

The Elimination Diet Has 4 Phases

Phase 1 Planning: You Can Start Right Now!

You can start your elimination diet the minute you finish reading this article! The first thing to do is make a plan. In the days leading up to your Elimination Diet:

Start to cut back on all of the above in your diet. If you are a regular coffee drinker, switching to green tea the week before the elimination diet will make your transition a lot easier.

Fill your pantry and fridge with the foods and ingredients you’ll need for the first week of your elimination diet.

If you are new to a natural foods diet, no worries – there is a wealth of websites with natural, healthy – and delicious – recipes that you’ll be able to eat on your elimination diet.

Plan to start your elimination diet on a weekend so you have those first couple of days at home to get used to the changes you’ve made, and also to plan ahead with meals and any cooking prep you’ll want to do so you can bring lunches to work as needed.

Make a mental plan for what you will do if you are craving foods that are off-limits. Examples include phoning a friend who you’ve designated as a support person while you’re doing elimination diet, writing in a journal, taking a walk or putting on some music and dancing, and having healthy food substitutes for snacks and go-to’s if your resistance is low.

Phase 2: Doing It!… Boot Out the Triggers

During the elimination phase you do just that – you completely avoid anything on your do not pass your lips list.

You have several options of how to roll with this:

You can do a comprehensive elimination diet by removing all of the foods listed below,

You can do a more specific elimination diet of just gluten, dairy, coffee, sugar, or a combination of these if you think you’ve already identified the most likely culprit, or feel you can only handle a limited amount of food eliminations at a time, or

You can start with a more specific elimination diet of the most common triggers and eliminate additional items such as grains and beans if symptoms persist after a couple of weeks on the more liberal version.

The foods that are most important to eliminate are common food triggers of allergic and inflammatory reactions including:

All flour products (if you eat grains*, they should be whole grains, for example, cooked brown rice, quinoa or millet)

Corn

Peanuts

Soy

Sugar

Eggs

Caffeine-containing foods and beverages (green tea is ok in moderation)

Vinegars and fermented foods

Yeasted products

Alcohol

Nightshade vegetables (tomatoes, eggplant, peppers, and potatoes)

Poor quality oils and fried foods

Fatty meats, processed meats

*For some people starches are a problem, so going bean and grain free might be helpful for part of the time

Foods that you tend to crave (these are often sneaky culprits of inflammation!)

Foods that you already know causes symptoms

“Comfort foods” (again, sneaky culprits and code for “craving”)

Foods that you eat day in and day out – your body can start to see these as inflammatory triggers if you have leaky gut – which many of us do!

Ideally, many medications would be stopped, especially reflux medications, NSAIDs (ibuprofen, Naprosyn, etc.), and antibiotics – because these can have a negative impact on your digestion, but this should be medically cleared with your primary care provider!

If you have reflux and are stopping your medication, DGL licorice is a great alternative to PPIs and H2 blockers to control your symptoms and heal your stomach. The usual dose is 2-3 chewable tablets before or between meals as needed. Again, check with your primary physician.

Don’t Worry! There’s PLENTY to Eat!

Some of you reading this must be thinking, “Well, she’s now put my entire diet on the ‘can’t eat it list’ – so what am I gonna’ eat? Actually, most of what’s on the above list isn’t a staple part of an optimally healthy diet anyway. And there’s a LOT you CAN eat. For example, all of the following are fair game, in appropriate portion sizes, of course:

Make Sure to “Take Out the Garbage” – Daily

To optimize the benefits and results of The Elimination Diet it is important to take out your garbage daily. I mean your digestive garbage! The goal is one healthy BM every day. Plenty of fiber from fresh vegetables and ample water is important. Supplements such as flax seed, psyllium, and magnesium citrate up to 600 mg/day (all available at your local pharmacy or health food store) are safe for most people to take daily and can help move things along if you’re slow.

Phase 3: “The Food Challenge”

After you’ve done the elimination phase, you are going to start introducing foods back in. The caveat here is that if you are pretty sure particular foods were causing symptoms, and now you no longer have those symptoms, you can simply keep those foods out of your diet going forward, without “challenging” with them.

To do the challenge, start by reintroducing a small portion of a food from a particular food group (i.e. dairy, gluten, grain, etc.) at breakfast. If you have no reactions then larger portions with lunch and dinner. Keep the food in your diet for a couple of days. If it doesn’t cause symptoms, it is likely not a problem in the diet. If if does, then that food might be a problem for you. In this case, you either want to keep it out of your diet, or keep it out for a few months while doing a 4R Program to heal your gut, and then re-challenge with it.

Foods that cause a true allergic reaction (swelling, shortness of breath, etc.) should not be reintroduced and if there is an actual allergic reaction, medical attention should be sought.

Phase 4: Life After the Elimination Diet

Phew, you’re done with your elimination diet. Now what do you do?

Simple: If you’ve had clear and obvious results you can simply keep the offending foods out of your diet, making sure that you are getting your nutrition from the foods you can eat.

Working with a functional medicine doctor or nutritionist knowledgable about whole foods can also be helpful as you make sustainable make long-term changes in your diet. Healing a leaky gut, a common culprit in food intolerances, may eventually allow you to reintroduce foods with impunity.

The elimination diet takes a little bit of planning and coordination, but it is simple to do and can make a huge difference in your health!

71 Comments

I try to look at how little kids eat over 3 days rather than just one — it’s less worrisome that way and they’ll often get what they need here and there. Keeping only healthy foods around so kids don’t develop a taste for goodies and not veggies is important. Offer the veggies over and over a lit of different ways. Apparently it takes 10 tries with different forms of a veggie to determine whether a child is TRULY averse to it. Make veggies fun — dips often help with both raw and cooked veggies. And worst come to worse, a chewable multi until the food variety grows and lots of berries which are chock full of nutrients! 🙂 More to come on feeding kiddos!

Aviva- Your cornerstones to owning your health project is pure genius! I am very excited to see where this series will lead. Thanks for your upbeat, can do, right on the money delivery of such important information. It will be life changing for so many. I did an elimination diet back in the 80’s and it changed our family culture- shifting us out of taco bell and big macs, and into the world of wonderful whole foods. Learning what works for your body truly is foundational to our health. Thanks again!
“Let food be your medicine and medicine be your food” 🙂

thank you! yes, absolutely, especially i baby has eczema, allergies, or other symptoms — or if you are having health symptoms. not a restrictive diet or detox — just the elimination diet! be well! aviva

This has great info! What if a breastfeeding mom or anyone is on a very restricted diet because finding several items to eliminate. Would you recommend she see someone? A gastro doctor, naturopath or where could one get further help when needed?

Thank you Aviva for your elimination diet. I have digestive issues and joint issues and major cravings. looking forward to feeling better:) If you dont mind me sharing…I like to sneak veggies and other healthy things into dishes for husband and kids. Canned pumpkin can be mixed with any tomatoe sauce and can even be replaced for tomatoe sauce since nightshades are triggers for me. I also put flaxseed powder in baked goods and reishi mushroom powder in everything.
Thank you for who you are and taking time out for us all. You are a treasure!!!
Love
Nicole

great info.
One quick specific question related to the question of “milk alternatives” and safety for children under 5. What do you recommend as a “milk” substitute….questions related to safety of rice milk and many hemp milks have brown rice syrup, etc.

There’s a newly rediscovered Paleo food called Tiger Nut, which is a small tuber, that can serve as a snack or be made into milk. It’s prebiotic, naturally sweet, is not a nightshade, and is not actually a nut. The milk, unsweetened, is delicious.

I, too, am excited to see the other posts in your “Health Cornerstones” series! This was a great post! I wish all doctors out there would START with lifestyle changes instead of assuming their patients are too lazy or unwilling to change.

Aviva, thanks for this excellent post!
I have a couple of questions:
1- Why beans should be removed? I don’t eat meat so they, along with lentils, are part of my daily diet.
2- I’ve become gluten free through an elimination diet process as well. I don’t suffer from mood swings and joint pains anymore. However, I still have some of the symptoms associated with a diet that is rich in grains. I only eat whole grains such as oats, quinoa, millet, and buckwheat. I avoid brown rice due of its high glycemic index. I have a 3 months baby boy and even though I officially didn’t develop gestational diabetes during his pregnancy my glucose level was relatively high (110 on the glucose screen). I now think that has a lot to do with the fact that I rely a lot on healthy grains to keep me full since I don’t eat meat ( I dropped meat about two years ago). From a health standpoint would make more sense to add the meat back on my diet and drop the grains? I am really concern with developing diabetes and even though I eat lots of veggies I wouldn’t be able to make it without the grains unless I add the meat back. I also don’t eat dairy, but I do eat eggs.
Thanks a lot for sharing your wisdom and knowledge with us! Your website is my number one place to go 🙂

Hi Giovanna
Beans are very high in carbs so can still cause some of the digestive problems, and some of the phytochemicals in red beans can be particularly troublesome to the immune system. Lentils are often ok — they are legumes. Millet and oats can cross react with proteins that trigger zonulin and occludin which are involved in leaky gut — and therefore can be a problem even when you’re off gluten. Coffee can, too. I’ve been adding meat back to a lot of vegetarians’ diets and they are responding well — both with better mood and energy, and also glucose e and other blood measurements. I was a vegetarian for nearly 2 decades and can attest to this — though I added meat back about 20 years ago — during my 4th pregnancy (the first 3 were vegetarian pregnancies). Make sure to eat organic, grass fed, no antibiotic meat sources — the extra cost is worth the health value. Best wishes! Aviva

I added the meat back this week and dropped the grains completely just as a test. And what a difference! I feel that my body is well nourished and my legs are much lighter. Even, my baby’s poop went back to the normal yellowish color and his constipation is gone. Isn’t that amazing? It’s been hard though to live without breads – I hope I can stick to it. I wish I could find a holistic doctor like you here in North Jersey 😉 Thank you so much, Aviva!

Did you ever find a holistic doctor in North Jersey? I’m in Bergen county and gave been struggling top find an affordable naturopath nearby. Would love to correspond with you – feel free to email me. [email protected]
Thanks!!!

Thanks once again, Aviva! Excellent info and so wonderful to know you really care about our health! I just checked out The Plan because I heard it recommended on some blogs. It is a similar concept, but condensed to much shorter time frames of elimination and reintroduction, and she says foods like almonds and salmon are often reactive for her clients. If the Amazon reviews are any indication, some people are having a lot of success with that method. Why do you think they could get results so much faster? And why the different foods? I love your blog and your books, and very much respect your opinion!

Hi Carol. I don’t know this plan but will check it out. But yes, some people are sensitive to many different foods in which case healing the gut (i.e. a “4R program”) is so important in improving food tolerance.
Warm wishes!
aviva

Okay, I’m ready to try this I’m 62 years old and 62 pounds over weight. this looks great as I’m a carb junkie–love my doughnuts and sweets. I don’t have any food intolerances that i know of but one can always hope that doing this along with getting the exercise back in I’ll be on the fast track to a healthier lifestyle.

As always, excellent info and so wonderful to know you really care about our health!

Hi Aviva,
I wrote you yesterday, and see that somehow my question disappeared, so I’m trying again..
I have Fibromyalgia and suffer from a debilitating fatigue on top of the pains and other symptoms. I am very interested to know if you have experience dealing with this, and will appreciate as much information and suggestions as you care to share.
Thanks,
Naama.

It’s suuuuuuper tough when you’re a vegan. Been there. There can be a lot of health benefits to a vegan diet — but I also see a lot of symptoms in my patients who are on one. Bloating, gas, always hungry, even sometimes weight gain….

Hi Jessica,
A functional or integrative nutritionist, or MD, or a naturopath would be able to provide your with excellent guidance….Also, you could follow a basic elimination diet for a couple of weeks — see one of my elimination diet blogs. ~ Aviva

Aviva,
I posted these questions already but the appear to have disappeared. I was also wondering if stevia is ok? If one is eliminating nightshades, are sweet potatoes ok? Oh, and how about tapioca starch and coconut flour? Thank you for time and all you do!
Sincerely,
Janel

Hi Janel,
It’s all very individual … I’m not a fan of stevia, coconut flour is generally well tolerated, some folks are sensitive to tapioca at least on testing I see in my practice so that varies….And sweet potatoes can be very healthful so I’d say experiment and pay attention to what your body tells you.

Sweet potatoes are ipomoea batatas and are in the morning glory family and according to the Sow True Seed catalog the greens of the sweet potato plant are edible and are great sauteed in mid summer when other greens are scarce in warm climates

Will you explain why you are not a fan of bone broth and stevia? What if one only uses organic, hormone and antibiotic free poultry for the bone broth and only organic stevia?
Thanks very much. I enjoyed reading your blog.

I have concerns about concentrated heavy metals in bone broth — but if it is organic, it is probably ok. As for stevia, it does require extraction methods that take it from it’s pure form, unlike honey, raw sugar, or maple syrup.

Thank you for all the information. My son is 11 and we have cured his allergies, asthma, depression, anxiety and suicidal thoughts. He’s off all medication and we make sure all of his food is homemade and 90 percent is organic. He is intolerant to MSG, all preservatives, soy lechthin, canola oil and artificial dyes. We’ve learned so much in the last 3 months and he is finally happy.

hi! i eliminate nuts just during the elimination diet because quite a number of folks seem to be sensitive to tree nuts in general; many of my patients with autoimmune conditions, for example, with joint pain, notice direct relationship between their joints hurting and eating nuts, surprisingly, especially almonds. also, overdone, which can happen on an elimination diet, they can be constipating. but if you tolerate them well, feel free to include them!

I’m a fan of dinner for breakfast — so stir fries, for example, with chicken or tahini. Smoothies are a good choice especially in warmer weather. And you can do millet, buckwheat, and brown rice in place of oats — I love rice pudding with almond butter, for example, and on my blog there’s a millet breakfast cereal. Breakfast is tough, though — I get that!

could you let me know what to eat as protein? I’m vegetarian and want to cut back soy (tofu and tempeh) for 3 weeks, and i cant digest beans – what would you suggest that i take to give my body the daily protein requirements?

Also, is it advisable to take probiotics while on the elimination diet?

Hi! Useful post! I love your work! I am an herbalist from Boulder, CO!
I just had a baby and I have been on a serious elimination diet to help with thrush (candida overgrowth) in baby’s mouth and my breasts. Cutting out all sugar, carbs, and starches seems to be the only that has helped with the symptoms! However, have you any advise on other digestive issues that may arise during an elimination diet? Specifically, loose and urgent stools & difficulty digesting all the meat and vegetables that replaced everything else. I am using calendula, plantain, & althea as my main healing gut herbs, along with some others for flavor and digestive support. Any thoughts on how to support the digestive system WHILE doing an elimination diet?

This is Megan from Dr. Aviva’s team. Thank your for your post and congrats on baby! I wanted to point you to a blog that Dr. Romm wrote where she speaks to the powers of the 4R program (Remove, Replace, Reinoculate, and Repair). It’s a great companion when working with the elimination diet. http://avivaromm.wpengine.com/10-signs-leaky-gut . I hope this helps!

Every time I try an elimination diet or clean(er) eating I can’t sleep at night. I was sleeping just fine before starting and I haven’t changed anything but my diet. Do you have any suggestions that might help? I’m guessing something is throwing my cortisol levels off? I have trouble falling asleep and if I wake up during the night I cant go back to sleep.

As we go through elimination diets, we can go through a bit of detox, and that can show up differently for everyone. For some, it may be more lethargy, or headaches, and for others it could show up as what you are going through. In a case like yours, Dr. Aviva recommends working with a practitioner as it sounds like a little extra guidance is needed. In the mean time, here is a direct link to an article that Aviva wrote on sleep that I have found to be very helpful. http://avivaromm.wpengine.com/sleep-well-7-natural-tips-for-getting-great-zzzzz

Thank you so much for this post. I am 26 years old and have had eczema since childhood, though it has become more severe and persistent within the last 10 years or so. I would like to try the elimination diet, specifically focusing on eliminating dairy, gluten, alcohol, sugar, and nightshades, but I am wondering if I should eliminate these all at once or start with the one(s) that I suspect to be most likely of contributing to my eczema. If I were to eliminate all at once, I am confused as to how I would know which one(s) is the culprit. I guess I would be able to tell once I introduce each ‘food group’ one by one. But how much time should I leave between each introduction. I am concerned that symptoms will be delayed and therefore I will be unable to pinpoint the culprit. For example, if I first reintroduce dairy and experience no negative symptoms at first, and then 2 weeks later reintroduce gluten and start experiencing negative symptoms, do I just assume that it is the gluten or could it be a delayed reaction to the dairy? Perhaps this is false, but I have heard that it takes a while sometime for you body to react to what you eat, of course, that is if it is not a severe allergy. Anyhow, any and all recommendations would be greatly appreciated. Thanks!

According to recent research for those with IBS and elimination or FODMAP based diets, people should know that garlic and onion or horrible for you. These contain fructans and often are a culprit for many people.

Hi Dr. Romm. A little background. I’m a 37 year old with fibromyalgia, depression, anxiety, hypothyroidism, pcos, IBS. I am a vegan and have been on the elimination diet, eliminating only gluten, for about 4 weeks. I have been feeling absolutely horrible the entire time. Fatigue, anxiety and depression all exacerbated, joint and muscle pain, and very frequent bm. Is this normal? I don’t know what to do. I’d consult with my md but she is not functional at all, and already criticizes my vegan diet. If you could give me any advice I would appreciate it so much. You are my go-to for everything, I look so forward to the day when I can afford to be your patient. Thank you so much for what you do.

Thank you for your comment and I am sorry to hear that you are not feeling well. Honestly working with an elimination diet can be a bit tricky when you are on a vegan diet. Working with a skilled nutritionist who has a deeper understanding of a plant based diet would be best in your situation so that you can get some one-on-one help. Also, have you listened to Aviva’s podcast with Alex Jamison? Honestly when I read your comment that articular podcast popped into my head and I think it could be really helpful for you to listen to it! I hope this helps.

This is so encouraging! I’ve been following an autoimmune Paleo diet for 6wks and just started reintroducing foods. A major difference between AIP and what Aviva is recommending is that she seems to allow certain whole grains, nuts, seeds and lentils. What is the reasoning for this? Any concern about antineutrinos? Also, why are lentils ok and not other beans? If I could eat quinoa, rice or lentils, I would seriously welcome the variety (and fiber) in my diet! Thanks for and amazing Teleseminar!

The elimination diet and the AIP diet are so very different and they are used and worked with for different reasons. Lentils are a bit easier on the digestive system (for some) as they contain what is called resistant starch. Stay tuned for more as Aviva will be releasing her Gut Replenish Program in a couple of weeks! She will be announcing the course in her weekly email she sends to people who have already joined her list and through Facebook!

Good day! After my midwife turned me onto it, I am following your excellent program in The Adrenal Thyroid Revolution and am embarking upon Week Three. Thank you so much for all of this! I just have so many questions, but my most burning one is this. While I don’t have hardly any other symptoms, I have had Polyarthritisis with a Rheumatoid Factor for 11 years now. I was 23 when I got it. Now turning 34 next week and getting to week 15 on my 6th baby (7th pregnancy), while I have felt a mini boost in energy and less headaches, i actually have more pain than ever and I don’t know how I can start adding foods back in yet as I feel worse without them. ???? I’m wondering, in light of how long I have had this disease, if I need to do part(s) or even all of the stages of the program for a longer period of time than most? Or continue on, or what would you recommend? I should also mention that at least as far back as my great-grandmother in the late 1880s, we have all had “the rheumatiz”; and I wonder if I’m simply stuck with it. Thank you sincerely again!

Hi Miranda, Thank you for writing. My guess is that this all has something to do with something your body still needed because you’re pregnant – so take a more modified approach to the plans – and keep grains in while you’re pregnant – this might have been the culprit. I always recommend keeping out all processed foods, sugar and gluten at least. Given the long family history – this does make things more complex and really, a consultation with a knowledgable integrative or functional medicine doctor, after baby is born, is probably going to be the most helpful for you. Not sure that you’re simply stuck with it – but you likely need a personally tailored plan. And pregnancy certainly makes it harder to do some of the herbs and supplements that might really benefit you. You can do some ,though, like fish oil and a probiotic which I think most pregnant women benefit from! Best with baby 🙂